Provider Demographics
NPI:1376959387
Name:IATRIDIS, TERESA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:IATRIDIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GLEN CEDARS DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7607
Mailing Address - Country:US
Mailing Address - Phone:404-353-0134
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW STE 801
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9524
Practice Address - Country:US
Practice Address - Phone:770-917-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist